This is an age 25- to 27-year follow-up of a birth cohort (N = 295), half of whom were prenatally exposed to cocaine. Nothing is known about the effects of prenatal cocaine exposure (PCE) on the transition into adulthood or on the long-term cascade of events from PCE through childhood and adolescence to adult substance use and abuse, psychiatric disorders and symptoms, and risky sexual behavior. This is a critical developmental time point because 1) rates of substance use and abuse peak, 2) problem behaviors and psychiatric disorders peak, and 3) risky sexual behaviors increase. Research prior to this age on these outcomes is not definitive because subjects have not been followed through this risk period of change. There are significant effects of PCE on child and adolescent outcomes including problem behaviors, cognitive deficits, and increased rates of substance use. There are no data on how these deficits are manifested in adulthood. We hypothesize that these earlier effects of PCE will predict deficits in adult functioning such as criminal behavior, substance use disorders, and risky sexual practices. This time point in adulthood will allow us to model the longitudinal relations between PCE and the outcomes and to define which outcomes are mediated by earlier effects of PCE. In this longitudinal study, the pattern of PCE represents the typical pattern in the general population: cocaine use at low and moderate levels early in gestation, with decreases in use in later gestation. This cohort is unique: 1) the sample is racially balanced; 2) we have retained 76% of the birth cohort for over 20 years with no biased attrition; and 3) we have a wealth of data on the prenatal environment and on the offspring from birth to 21 years, including measures of cognitive development, psychological status, psychiatric diagnoses, substance use, behavior, maltreatment, and violence exposure. Data are collected at each prenatal and postpartum phase on maternal substance use, environmental characteristics, family structure, sociodemographic factors, and psychological status, domains that are important precursors of adult outcomes. Based on our earlier findings and the normal changes during this developmental period, we will identify how those with PCE differ from the unexposed with respect to substance use, psychiatric disorders, and risky sexual behaviors and determine how earlier consequences of PCE influence 25- to 27-year outcomes. From these results, we will develop a heuristic model that represents the combined direct and indirect effects of PCE across time on the adult outcomes. Correctly understanding the pathways to adult problems associated with PCE will allow the development of appropriate treatments that consider the underlying exposure. 1